The “Fourth Trimester”

by Donna Walls RN, BSN, ICCE, IBCLC

The initial transition to motherhood is unique for every mother/baby dyad. It is a time of exploration, nurturing, learning and falling in love. This transition time is celebrated and supported with very different traditions around the world.

An overriding philosophy in most western cultures has changed from what was viewed as the “lying in period” of rest for 3-4 weeks post birth to the present concept of encouraging self-care when the mother focuses on restoring her health to be able to care for herself, her newborn, and her family as quickly as possible.

In many other cultures, the emphasis is on a prescribed period of time focusing on rest and recovery while friends and family care for the mother and often her family and home. The mother’s only responsibility is caring for her infant. In China, the postpartum time literally means “sitting the month” when new mothers are served nourishing foods aimed at restoring health and supporting lactation. In Korea, the resting period post birth is commonly referred to as “the 100 days of birth” while in Japan the “ansei” means “peace and quiet with pampering” for the first three weeks.

In India, the “confinement” lasts from 40-60 days and includes herbal baths and massages. In Africa, new mothers remain quietly at home for 10-40 days, and in some African countries it can be up to three months with friends and family taking care of her home and other children

In Mexico, “la cuarentena,” translates to “quarantine” and continues for forty days which some studies have shown to encourage infant and mother bonding.

In Holland, a “kraamverzorgster,” a qualified healthcare professional, provides care at home to mother and baby during the first eight to 10 days post birth and is a mandatory part of maternity care. These women are generally in the home for 5-6 hours a day and provide physical, emotional, and breastfeeding support, much like the role of the postpartum doula in the United States.

In the United States, new mothers often face returning to work or school within 2-4 weeks after giving birth. This early transition time can be challenging with altered sleep patterns, uncertainties of the new maternal role acquisition, and changing relationships with spouse and other family members. Early return to previous job or school schedules can exaggerate anxieties or concerns common in this timeframe.

There are conflicting opinions on which care tradition seems to be the most advantageous. Is extended rest harmful, leading to complications? Or, is early return to physical activities resulting in increased risk of complications? Unfortunately, there is little research on this topic

The postpartum period associated with healing and physical return to the non-pregnant state is generally recognized as six weeks. This time period allows for uterine involution, establishment of lactation, and adjustment to the role of mother.

Women have always sought other women, both family and friends, for guidance and support. This tradition of passing along knowledge and wisdom regarding infant care, emotional changes, physical expectations, breastfeeding support, and sexuality can become difficult when women are geographically separated from female family members or close social support.

Resources
Postpartum Maternal Health Care in the United States: A Critical Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595301/
Factors Associated with Postpartum Maternal Functioning in Women with Positive Screens for Depression.Barkin JL, Wisner KL, Bromberger JT, Beach SR, Wisniewski SR. J Womens Health (Larchmt). 2016 Jul; 25(7):707-13. Epub 2015 Nov 24.
The inadequacies in postnatal health care – ScienceDirect
http://www.sciencedirect.com/science/article/pii/S2352081716301623 by N Fogel – ‎2017
Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health.
Shaw E, Levitt C, Wong S, Kaczorowski J; McMaster University Postpartum Research Group.
Birth. 2006 Sep;33(3):210-20
Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: views of British midwives.Aquino MR, Edge D, Smith DM.
Midwifery. 2015 Mar;31(3):373-9. doi: 10.1016/j.midw.2014.11.006. Epub 2014 Nov 13.
Understanding and meeting the needs of women in the postpartum period: the Perinatal Maternal Health Promotion Model. Fahey JO, Shenassa E. J Midwifery Womens Health. 2013 Nov-Dec;58(6):613-21. doi: 10.1111/jmwh.12139. Epub 2013 Dec 9. PMID:24320095
Social support during the postpartum period: mothers’ views on needs, expectations, and mobilization of support. Negron R, Martin A, Almog M, Balbierz A, Howell EA.
Matern Child Health J. 2013 May;17(4):616-23. doi: 10.1007/s10995-012-1037-4.PMID:22581378
The role of maternal self-care in new motherhood. Barkin JL, Wisner KL.Midwifery. 2013 Sep;29(9):1050-5. doi: 10.1016/j.midw.2012.10.001. Epub 2013 Feb 15. PMID:23415369

Flourishing in 2017 for ICEA

The ICEA Board and staff were very busy flourishing for ICEA in 2017 to meet the needs of the membership. We started by looking at the results of a survey held in 2016 and then moved to prioritizing what we need to accomplish.

One of the big items was the streamlining of membership and certification because we heard from the membership about the need to simplify the process of membership and certifications.  The planning started in January, the behind the scenes preparation began in spring, and the implementation of the streamlining took place in in late summer/early fall. We now have a more user friendly process for all!

With the streamlining changes being added to the website, other improvements were also made to enhance the website including:

  • Updated vision, mission and core values
  • Inclusion of a equity and diversity statement
  • Added and updated Position Papers

Another milestone for ICEA included receiving provisional accreditation for ANCC (American Nurses Credentialing Center). Many organizations now require certifying bodies to have ANCC, and ICEA frequently received phone calls and emails from the membership about the need. We rolled up our sleeves and put a dedicated and experienced group of nurses and educators together to get the job done.

ICEA launched the online PCBE program to help those who could not attend workshops but could do the work online for obtaining their certification. We developed a rubric for the scholarship program to provide support to those seeking certifications. To meet the need for obtaining contact hours, monthly webinars were offered for the first time. Plus, our social media committee worked hard to keep the membership updated with current evidence based information and other relevant articles.

ICEA was also very busy growing internationally. We signed an International Teaching Partnership agreement with the Chinese organization – YANMA. This came about due to the hard work of our Education Director, Tamela Hatcher, who has been teaching workshops in China for the past two plus years. There is a hunger and a need for Childbirth Educators and Birth Doulas in China. Another first for ICEA was appointing our first International Director from outside the US, Deryse Simone Van Aardt, who is located in South Africa and began her term this month.

It is easy to see that we have a strong Board and supportive management company (IMI) to help ICEA be the best. It has been a privilege to work with these ladies, and I look forward to what 2018 has in store.

Flourishing for ICEA,

Debra Tolson, RN, BSN, ICCE, IBCLC, CPST
ICEA President

Breastfeeding in Public

by Cynthia Billiar, BSN, RN, IBCLC, ANLC, ICD, CD(DONA), ICCE

Source: United States Breastfeeding Committee

Have you ever wondered how we got to the place that we need laws to protect a breastfeeding mother’s right to feed her baby wherever she may be? Every state in the U.S. except Idaho, along with the District of Columbia and the Virgin Islands, has laws that protect a mother’s right to breastfeed her child in any public or private location. They also exempt breastfeeding from public indecency laws, (Breastfeeding laws, 2017). There are also laws here in the U.S. that requires employers to provide reasonable break time, unpaid, for breastfeeding mothers to express breastmilk until her breastfeeding child’s first birthday, (Fitzpatrick, 2010).

Breastfeeding in public is a concern for most breastfeeding mothers. They worry that they will be told to cover up or even asked to leave or go in to the bathroom.

None of us would be here today if our ancestors had not breastfed. Mothers in colonial America were expected to breastfeed their children and they typically breastfed their children until about two years of age. Breastfeeding was common for colonial women; they believed that breasts were created to feed their babies, (McCall, 2014).

Medicine, science, and technology created huge changes in infant feeding in the eighteenth and nineteenth centuries. Artificial milk became available in the nineteenth century primarily to feed the orphans in institutions. Milk factories were providing pasteurized cow’s milk and home sterilizers by the late 1890’s, (Lauwers & Swisher, 2016). Pediatricians emerged and were considered to be infant feeding experts. They were and some may continue to be heavily influenced by the infant formula industry. By the twentieth century artificial feeding grew to be considered the modern and civilized way to nourish infants. Artificial feeding became associated with high class and educated women. Breastfeeding, on the other hand, became associated with the poor or lower social status women, (Lauwers & Swisher, 2016). Women entered the work force in large numbers during World War II and many enjoyed the freedom and challenge of working outside the home. More mothers working outside the home increased the need for artificial feeding.

In the 1950’s men’s magazines and mass media began to idealize breasts in a sexual way. This created a focus on female breasts as sex objects and undermined their function of nourishing and nurturing their babies.

Breastfeeding reached its all-time low in 1971, when only twenty percent of mothers breastfed at least one time before leaving the hospital here in the United States, (Lauwers & Swisher, 2016). Imagine for a moment living in 1971 and seeing a mother breastfeeding her baby. You would see it as out of the norm and even strange; which is why we now have laws to protect the rights of breastfeeding women and their infants.

What we see through history is that women fed their infants according to what was seen as the norm for that time. It was common, expected, and the norm, for the colonial women to breastfeed their infants. By 1971 it was not common or the norm for American women to breastfeed. The United States breastfeeding in public laws have given women the ability to step out and breastfeed their infants wherever they may be. With more women breastfeeding in public our hope is that it will soon become the norm once again.

There are a few tips that can help make breastfeeding in public a little easier. First be familiar with the breastfeeding laws in your state. Keep a copy of the laws with you to help educate anyone who might question your right to breastfeed your baby in public. If you are more comfortable being covered up try dressing in layers and pull your top up from the bottom rather than the top down. Some mothers find wearing two camisoles works well; pull the top camisole up from the bottom and the under camisole down from the top. The bottom camisole keeps your tummy covered and the top camisole covers the top part of your breast. There are several types of breastfeeding cover ups sold in stores and online that you could try. Some mothers are comfortable breastfeeding while carrying the baby in a strap on carrier. Keep your eyes up because people will always look where you are looking. Practice breastfeeding at home in front of a mirror before going out for the first time. Go with other breastfeeding mothers as you will find strength in numbers.

What can we the public do to help normalize breastfeeding? When you see a mother breastfeeding her infant, offer a smile or give her some words of encouragement. Have some little post cards made up ahead of time that you can give a breastfeeding mother with a note that says ‘thank you for breastfeeding’ or ‘great job.’  If you see a mother being hassled for breastfeeding her infant in public, be her advocate. In order for breastfeeding to become the norm, the public needs to see it. We, as breastfeeding advocates, need to encourage mothers to breastfeed when and wherever their infants need to be fed. Empower women by educating them on state and federal laws that protect their rights as breastfeeding mothers. Never be afraid to advocate for breastfeeding at state and federal levels of government whenever you get the opportunity. Stand strong, be a voice, and create a path that will empower the breastfeeding women of our nation.

References
Breastfeeding state laws. (2017). Retrieved from http://www.ncsl.org/research/health/breastfeeding-state-laws.aspx
Fitzpatrick, R. B. (2010). Lactation provisions in the patient protection and affordable care act. Retrieved from https://www.americanbar.org/newsletter/publications/aba_health_esource_home/volume7
Lauwers, J., & Swisher, A. (2016). Counseling the nursing mother (6th ed.). Burlington, MA: Jones & Bartlett Learning.
McCall, S. (2014). Nursing in public: What U.S. mothers faced from colonial times until now. Retrieved from https://breastfeedingusa.org/content/article/nursing-public-what-us-mothers-faced-colonial

Bottle Feeding: Is There a Risk?

 

by Cynthia Billiar, RN, IBCLC, ANLC, ICD, ICCE

More than 85% of lactating women in the United States express their milk some of the time. Of those pumping, 5.6% are exclusively pumping and feeding by bottle, (Keim, Boone, Oza-Frank, & Geraghty, 2017). This is not surprising because we know that 70% of women with children under the age of 18 in the United States participate in the labor force, (“https://www.dol.gov/wb/stats/stats_data.htm,” 2016). Women who are actively serving in the United States Armed Forces make up 15% and this number continues to rise, (Feinstein, 2016).

The AAP recommendation is to exclusively breastfeed for the first 6 months, followed by continued breastfeeding along with complementary foods for 1 year, or longer, as mutually desired by mother and infant, (Eidelman & Schauler, 2012). Listed in order of least healthy to healthiest, the best feeding choices are first, direct breastfeeding, second, mother’s expressed milk, then human donor milk, and last, formula, (Mohrbacher, 2010, p. 236). Many mothers choose to exclusively pump and feed their breastmilk from a bottle for various reasons.

With the explosion of breast pump manufacturers and insurance companies covering breast pumps, exclusive pumping is becoming more popular, so much so, that it now has a nick name, “EPing”. We teach our expecting families the importance of looking at the risks, benefits, and alternatives before making any decision.  You can imagine there are many questions as to the risk of choosing EPing. Let’s start with the pump itself.

There are many different pumps and choosing the right pump can be confusing. Mothers respond differently to different pumps. There is a risk that the pump will not remove milk efficiently, causing an end result of low milk production. A recent study found that EPing is associated with a shorter milk feeding duration and an earlier introduction of formula compared to those mothers feeding at the breast and not pumping, (Keim et al., 2017).

Storage of breastmilk, whether in the refrigerator or freezer, is found to have a reduction of some of the cells and antioxidants, (Rasmussen & Geraghty, 2011).  When an Eping, mother does not get the skin to skin contact and closeness with her baby, the mother’s perception of stress and mood are affected negatively, (Mezzacappa & Katkin, 2002). This lack of closeness can also affect the bonding of mother and baby.

Next, let’s look at the bottles themselves. Bottles can increase the risk for future orthodontic problems, such as needing braces and the increase risk of cavities. Direct breastfeeding encourages better lower jaw development and stronger facial muscles, helping with speech development, (Bechtloff, 2012).

We also need to consider the risk of contamination and the time it takes to sterilize the bottles and nipples.  There are several studies that indicate feeding from a bottle causes babies to overeat, increasing the risk of obesity, (Li, Fein, & Grummer-Strawn, 2010).

The most interesting information I found was the studies that indicate there is a difference in the milk itself. Research demonstrates that when an infant is breastfeeding, and he has an infection, leukocytes specific to his infection increase in his mother’s breastmilk. The mechanism behind how the leukocytes move into the breast during an infant infection is unclear. One possible thought is that during breastfeeding saliva from the baby’s mouth is back washed into the mother’s breasts, which stimulates an immune response, (Hassiotou et al., 2013).  This protection in breastmilk is both antibacterial and antiviral. These immunities are lower in the nonexclusive breastfeeding dyad compared to the exclusively breastfeeding dyad, (Hassiotou & Geddes, 2014).

As you can see there are risks to EPing. There are times when a mother has no choice but EPing and I salute you. I know it can be very difficult to be an EPing mother, much more difficult at times than breastfeeding directly. The demands of this busy world can make life difficult but the strength and determination of a mother can withstand it all.

References
Bechtloff, R. (2012). 5 good reasons for breastfeeding your baby. Retrieved from http://www.bracesbylanghornechildrensdentist.com/5-good-reasons-for-breastfeeding-your-baby/
Eidelman, A. I., & Schauler, R. J. (2012, March). Breastfeeding and the use of human milk. Pediatrics, 129(3). Retrieved from http://pediatrics.aappublications.org/content/129/3/e827
Feinstein, L. (2016). 7 shocking (and sad) statistics on women in the military. Retrieved from https://splinternews.com/7-shocking-and-sad-statistics-on-women-in-the-militar-1793857140
Hassiotou, F., & Geddes, D. T. (2014). Immune cell-mediated protection of the mammary gland and the infant during breastfeeding. Advances in Nutrition. Retrieved from advances.nutrition.org
Hassiotou, F., Hepworth, A. R., Metzger, P., Tat Lai, C., Trengove, N., Hartmann, P. E., & Figueira, L. (2013, April 12). Maternal and infant infections stimulate a rapid luekocyte responds in breastmilk. Clinical & Translational Immunology, 2. https://doi.org/10.1038/cti.2013.1
Keim, S. A., Boone, K. M., Oza-Frank, R., & Geraghty, S. R. (2017). Pumping milk without ever feeding at the breast in the mom2mom study. Breastfeeding Medicine, 12(7). https://doi.org/10.1089/bfm.2017.0025
Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2010). Do infants fed from bottle lack self-regulation of milk intake compared with directly breastfedinfants? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20457676
Mezzacappa, E. S., & Katkin, E. S. (2002). Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Retrieved from http://psycnet.apa.org/record/2002-00946-009
Mohrbacher, N. (2010). Breastfeeding answers made simple. Amarillo,TX: Hale Publishing.
Rasmussen, K. M., & Geraghty, S. R. (2011, August). The quiet revolution; breastfeeding transformed with the use of breast pumps. American Journal of public heatlh, 1356-1359. https://doi.org/10.2105/AJPH.2011.300136
Women in the labor force. (2016). Retrieved from https://www.dol.gov/wb/stats/stats_data.htm

Placental Encapsulation: Friend or Foe of Postpartum Mothers?

by Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

In recent years, a practice has appeared which involves the preparation of a woman’s placenta for ingestion. Preparation practices vary from dehydration to heat treatments. The dried and ground placenta is then placed in capsules for ingestion over the first days or weeks after birth.  Some recipes can be found for the use of the placenta for making soups, stews or smoothies to be eaten after the birth. This controversial practice has been cited as a common custom throughout history and often referred to as part of traditional medicinal systems. Many proponents of placental ingestion report the benefits of less postpartum mood disorders, enhanced breastmilk production, treatment of anemia and encouraging uterine involution.  Another rationale for ingestion points to the common mammalian practice of eating placentas immediately after the animal gives birth. Most authorities agree that this practice seems to be done for protection of the offspring by removing the smell of blood which can attract predators and not for nutritional needs. This immediate consumption also allows for the normal physiologic function of lactogenesis. After the initial surge of ingested progesterone dissipates quickly over the first hours and days, the increasing levels of prolactin stimulate early milk production.

Research supporting the safety and efficacy of placental ingestion, placentophagy, has been scarce as most information is anecdotal. Suggested benefits of placental ingestion range from less postpartum depression and treatment of anemia to improving milk production. Concerns include possible low milk supply issues and unregulated, unsafe preparation practices resulting in contamination and possible infections.  A case of neonatal group B Streptococcus sepsis was recently reported to the CDC  . The Centers for Disease Control and Prevention then recommended that the intake of placenta capsules should be avoided owing to inadequate eradication of infectious pathogens during the encapsulation process The Association of Placenta Arts provides guidelines for patients and providers but at this time, there are no regulations for the safety in preparation or storage or standardization of amounts needed for therapeutic effects.

The low milk supply concerns can be explained by the physiology of early lactation. Placental progesterone fills and activates the receptor sites on the alveolar (milk making) cells during the pregnancy and is responsible for colostrum production in the last half of the pregnancy. At birth and with the expulsion of the placenta there is a dramatic, rapid drop in the progesterone allowing the receptor sites to empty of progesterone and fill with prolactin, the hormone responsible for milk production. Prolactin is released when the infant stimulates the nipple during feeding or nipple stimulation occurs with expression of milk.

There is no clear answer to the question of how much of the active hormone remains after the preparation process is completed. If the hormone is degraded, there may not be a negative effect on early milk production. If progesterone remains physiologically active there is a concern.  Only one study (Young et al, 2016) found that hormones did remain active and in levels high enough to cause a physiologic response.

In my professional practice as a lactation consultant, I have found a connection between mothers who have low milk supply and ingestion of placenta. Many of these mothers complained that they never really felt the initial filling, and when they expressed their milk, rarely pumped adequate milk to meet their infant’s needs.  They struggled with supply, even after adding extra feedings or expression sessions and often began supplementing when there was poor weight gain in the newborn period. There were enough cases noted that I added a routine question about the practice of placental ingestion to my history when working with mothers who have milk supply concerns. I have also found, within days, there was a filling of the breast and an increase in supply when the placental ingestion was discontinued.

So, how can we respond to questions? Should we be adding placental encapsulation education in our childbirth or prenatal breastfeeding classes? At this time we are still not assured of universal safety assurances or universal warnings. As ICEA childbirth educators we should encourage investigation and asking questions about the preparation process from those they are considering receiving placental products. We encourage our clients to consider risks, benefits and alternatives in many aspects of childbearing and we should also encourage then to apply the same principles to the possibility of consuming placental products.

References
https://www.nichd.nih.gov/news/releases/Pages/062615-podcast-placenta-consumption.aspx
Coyle CW, Hulse, KE, Wisner KL, Driscoll KE, Clark CT Placentophagy: therapeutic miracle or myth? Archives of Women’s Mental Health. (June 2015)
Beacock M (2012) Does eating placenta offer postpartum health benefits? Br J Midwif 20(7):464–469
Cremers GE, Low KG (2014) Attitudes toward placentophagy: a brief report. Health Care Women Int 35(2):113–119
Kristal MB, DiPirro JM, Thompson AC (2012) Placentophagia in humans and nonhuman mammals: causes and consequences. Ecol Food Nutr 51(3):177–197
Laura K. Gryder, Sharon M. Young, David Zava, Wendy Norris, Chad L. Cross, Daniel C. Benyshek 3 November 2016 Effects of Human Maternal Placentophagy on Maternal Postpartum Iron Status: A Randomized, Double-Blind, Placebo-Controlled Pilot Study
Joseph R, Giovinazzo M, Brown M. (2016 Oct – Nov). A Literature Review on the Practice of Placentophagia.  Nurs Womens Health; 20(5):476-483.
Young, S. M., Gryder, L. K., Zava, D., et al. (2016). Presence and concentration of 17 hormones in human placenta processed for encapsulation and consumption. Placenta 43: 86-9
Young, S. M., Gryder, L. K., David, W. B., et al. (2016). Human placenta processed for encapsulation contains modest concentrations of 14 trace minerals and elements. Nutrition Research 36(8): 872-8
Marraccini, M.E., Gorman, K. S. (2015). Exploring placentophagy in humans: Problems and recommendations. Journal of Midwifery and Women’s Health 60(4): 371-9
Hammett, F. S.  The effect of the maternal ingestion of desiccated placenta upon the rate of growth of the breast-fed infant. Journal of Biological Chemistry, 36, 569–573.
Gryder, L. K., Young, S. M., Zava, D., et al. (2017). Effects of human maternal placentophagy on maternal postpartum iron status: A randomized, double-blind, placebo controlled pilot study. Journal of Midwifery and Women’s Health 62:68-79
Farr A1Chervenak FA2McCullough LB2Baergen RN3Grünebaum A2. Human placentophagy: a review. Am J Obstet Gynecol. 2017 Aug 30. pii: S0002-9378(17)30963-8. doi: 10.1016/j.ajog.2017.08.016. [Epub ahead of print]
Hayes EH. Consumption of the Placenta in the Postpartum Period. J Obstet Gynecol Neonatal Nurs. 2016 Jan-Feb;45(1):78-89. doi:10.1016/j.jogn.2015.10.008. Epub 2015 Nov 25.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6625a4.htm

SIDS Awareness Month

October is Sudden Infant Death Syndrome (SIDS) Awareness month and a time to take a fresh look at how we can educate parents and caregivers on reducing the risk of SIDS. According to the Center for Disease Control and Prevention (CDC), about 3,500 infants died in the United States in 2014 of Sudden Unexplained Infant Death. (SUID).

SIDS is the sudden death of an infant less than 1 year old that cannot be explained after a thorough investigation that includes a complete autopsy, examination of the death scene, and a review of the medical history. This is the most commonly occurring unexplained death of infants

Another definition to be aware of is Accidental Suffocation and Strangulation in Bed (ASSB) which is the sudden death of an infant less than 1 year of age that can happen because of:

  • Suffocation by soft bedding such as when a pillow or covers an infant’s nose and mouth.
  • Overlay, or when another person rolls on top of or against the infant.
  • Wedging or entrapment which is when an infant is wedged between two objects such as a mattress and wall, bed frame, or furniture.
  • Strangulation which can happen when an infant’s head and neck get caught between crib railings.

The original Back to Sleep campaign has been updated by the CDC and the National Institutes of Health to become the Safe to Sleep campaign. The campaign works hand in hand with The National Action Partnership to Promote Safe Sleep (NAPPSS) and other organizations to bring awareness to and provide education on SIDS and ASSB prevention.

Current research supports the following recommendation for SIDS risk reduction:

  • Always place babies on their backs when putting them to sleep for naps and at night.
  • Use a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet.
  • Share your room with your baby, not your bed. Your baby should not sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else.
  • Keep soft objects, such as pillows and loose bedding, out of your baby’s sleep area.
  • The risk of SIDS is even greater when a baby shares a bed with a smoker. To reduce risk, do not smoke during pregnancy, and do not smoke or allow smoking around your baby.

Absent from many of the messages is encouraging mothers to breastfeed, which confers a 50% risk reduction of SIDS, and an even stronger protection if the mother is exclusively breastfeeding. Recognizing that the sleep separately message can be confusing or difficult for breastfeeding mothers, the United States Breastfeeding Committee and NAPPSS worked with the American Academy of Pediatrics to develop a more “breastfeeding friendly” safe sleep message.

On October 24, 2016 the American Academy of Pediatrics announced their Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment.

The following recommendations were given supporting the updated policy:

  1. Breastfeeding is recommended to reduce the risk of SIDS and to enhance the health and well-being of the infant and the mother. The AAP recommends exclusive breastfeeding for 6 months (no formula, nutritional liquids or solid foods). Newer research demonstrates that exclusive breastfeeding can reduce the risk of SIDS by as much as 70%.
  2. Skin to skin care is recommended for all mothers and newborns, regardless of feeding or delivery method for at least an hour after birth
  3. Room-sharing with the infant on a separate sleep surface is recommended. Keep infants in close proximity to parents for the first 6 to 12 months of life.
  4. The AAP recognizes that parents may fall asleep in bed after or during feeding their infant, so remove pillows, loose blankets, loose sheets and move the bed away from walls to prevent entrapment, and follow remainder of safe sleep recommendations.
  5. Avoid nighttime feeding on couches and arm chairs which are not considered safe sleep surfaces at any time for infants.
  6. It is important that anyone who cares for the infant puts the baby to sleep on their baby on the back. Prone sleeping (sleeping on the stomach) increases the risk of rebreathing the same air that is under the baby’s face which can increase the levels of carbon dioxide in their blood, not enough oxygen in their blood which can be potentially fatal.
  7. Creating a safe sleep surface. Recommendations from the National Action Partnership to Promote Safe Sleep (in partnership with the AAP) recommends to:
    “Use a firm sleep surface, such as a mattress in a safety-approved crib covered by a fitted sheet, to reduce the risk of SIDS and other sleep-related causes of infant death. Firm sleep surfaces with no other bedding or soft objects. Nothing soft such as pillows etc. should be placed under the baby. Appropriate surfaces can include safety approved cribs, bassinets, and portable play areas. Safety approved cribs are those that have been manufactured and sold since the requirements went into effect on June 28, 2011. They have been designed to have the spaces between the bars too small for a baby’s head to get through and get stuck. Standards for other safety approved spaces such as bassinets, portable play areas and side cars (attachment to an adult bed that provides a separate, but close safe space) have also been developed by the U.S. Consumer Product Safety Commission, the agency that tracks accidents and deaths with products and helps keep babies safe from products that can be harmful or cause accidents. For information on safety standards for sleep products , contact the Consumer Product Safety Commission at 1-800-638-2772 or http://www.cpsc.gov.”
  8. Avoid smoking, alcohol, and drugs during pregnancy and after birth.
  9. Avoid devices marketed to reduce risk of SIDS such as monitors, wedges, devices or specific mattresses.
  10. Swaddling does not reduce the risk of SIDS and in some cases may increase the risk for overheating and SIDs.
  11. Consider offering a pacifier at nap or bed time, after breastfeeding is firmly established (no specified time frame). If the baby is not breastfed, then a pacifier can be introduced as soon as the family desires.
  12. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.

Teaching points for prenatal or postpartum education on safe sleep include:

  • Exclusive breastfeeding significantly reduces the risk of SIDS.
  • Newborns and new parents sleep better when in close proximity.
  • Always place infants on their back for any sleep.
  • Do not allow any smoking in the home. Encourage and provide information to help women stop smoking during pregnancy.
  • Swaddling has not been shown to reduce the risk of and may increase the risk of overheating and SIDS. Avoid swaddling during times of sleep.
  • Do not use couches or chairs for nighttime feedings.
  • Do not co-sleep if either parent smokes or is using alcohol or drugs which can alter responding to the baby.
  • All surfaces that an infant might be sleeping on needs to be safe. This includes cribs, cots, playpens, and the parental bed (if the mother falls asleep while feeding). A safe sleep surface includes:
    • Firm mattress
    • Well-fitting sheet
    • No blankets or pillows
    • No bumper pads
    • Use only equipment designated and approved for infant sleep
    • No surface that can entrap an infant
    • No toys or pets sharing the same sleep surface
    • Avoid swaddling or clothing that can cause overheating

ICEA recently updated our Position Paper on Safe Sleep which is available on our web site.

References
http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938
Centers for Disease Control and Prevention . (2015). Sudden unexpected infant death. Retrieved August 20, 2015, from http://www.cdc.gov/sids/aboutsuidandsids
https://awhonn.files.wordpress.com/2015/10/tips-for-nurses-teaching-safe-sleep-in-the-hospital-setting.pdf
Pease AS, Fleming PJ, Hauck FR, et al. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics. 2016-05-09 00:05:32 2016.
McKenna JJ, Gettler LT. There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping. Acta Paediatr. Aug 21 2015
Carpenter R, McGarvey C, Mitchell EA, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies. BMJ Open. January 1, 2013 2013;3(5)

2018 Conference Abstract Deadline Extended

Share Your Expertise at ICEA’s Conference

Due to the recent fires and natural disasters around the world, there have been requests to extend the deadline for abstract submissions for our 2018 Conference. As a kind gesture, we’re extending the deadline to Monday, October 2.

The conference theme focuses on ICEA’s newly defined core values:

  • COMPASSION: We believe approaching maternity care with compassion and a nurturing spirit improves birth outcomes for all families.
  • COLLABORATION: We practice a culture of collaboration based on the knowledge that mindful engagement with diverse groups advances positive, family-centered maternity care.
  • CHOICE: We support freedom of choice by training professionals committed to empowering expectant families through informed decision making.

If you have an idea for a presentation centered around one or more of our core values, we’d love to hear it! We’re accepting submissions for concurrent sessions, hands-on skills stations, and poster sessions.

All abstracts must be submitted through the online system by 5:00 PM ET on October 2. Abstracts will then be reviewed by the ICEA Conference Committee. Share your expertise today!

If you have any questions about submitting your abstract, please contact the office.

Tips for Successfully Submitting Your Abstract

Submitting your abstract can be easily completed by following the steps below.

  • Create a profile on the submission site– please note that all submitters will be considered First-Time Users this year
  • Complete information about the author(s)-  including bio, headshot, and contact info
  • Share information about your session- including session description, session type, session level, track, etc.
  • Upload completed EPT and COI
  • Make sure to see the submission to fruition- you will receive an email confirmation for each session that you successfully submit

Submit Your Abstract